Let’s be real: getting a denial letter from your Medicare Advantage plan can feel overwhelming and unfair. You’re doing everything right, and then—bam—a claim gets kicked back.

But here’s something you should know: most people who appeal a denied Medicare Advantage claim end up winning.

A 2023 KFF study found that only 11.7% of denials were appealed. But of those appeals, over 81% were successful. Translation? If you appeal, you’ve got a really good chance of turning that "no" into a "yes."

So if this happens to you—or someone you love—don’t just toss the denial in the drawer. Here’s what to do instead.

Key Takeaways

• Odds are in your favor: More than 4 out of 5 appeals succeed.
• Act fast: You have only 60 days to file an appeal.
• Get support: Free resources can help walk you through the process.
• A denial isn’t the end: There are multiple appeal levels if needed.

Why Medicare Advantage Claims Get Denied

It’s usually not malicious—it’s often paperwork. Here are the most common reasons:

• Lack of medical necessity
• Missing or incorrect documentation
• Need for additional information

That’s why the first step in your appeal is to really understand your denial notice. Read it carefully. Then move on to the action plan.

Step-by-Step: How to Appeal a Denied Claim

1. Review the denial notice
   Read it closely and follow the instructions for filing an appeal.
2. Talk to your doctor
   Ask them to write a support letter explaining why you need the treatment or service.
3. Watch the clock
   • You must file an appeal within 60 days of the denial.
   • If your claim is for care you haven’t received, the plan has 30 days to respond.
   • If the care has already been received, they have 60 days.
4. Need it faster? Ask for an expedited appeal
   If a delay could impact your health, you can request an expedited review, which must be completed in 72 hours.
5. Still denied? There’s more you can do
   If your first appeal is denied, it’s automatically forwarded to an independent review. And if needed, there are three more levels of appeal beyond that. (We’ll save those for another day.)

Feeling Lost? Get Help

You don’t have to go in it alone. Two fantastic free resources are:

• State Health Insurance Assistance Programs (SHIP)
• Medicare Rights Center

These organizations provide free, expert guidance and can walk you through the process step by step.

Bottom Line

If your Medicare Advantage claim gets denied, don’t give up. Most people don’t file appeals—but those who do, often win.

The odds are in your favor.